When it does not seem to be working: what to record before the review appointment
The most useful thing you can bring to a review is a dated record of what changed, what did not, and when you changed anything.
Without it, the appointment runs on recall, and recall after a bad fortnight reports that nothing has helped at all. That is not dishonesty, it is how memory works, and it makes a genuine partial improvement invisible.
Record symptoms separately. Different symptoms respond on different timescales, so a single overall impression flattens the useful information. "Flushes down from most days to about twice a week, sleep unchanged, mood better since week three" is a completely different clinical picture from "still no good," and it is the same six weeks.
Record the mechanics too, because they are among the first things a clinician will ask: which preparation, what dose, which route, from what date, and honestly how consistently you have taken it.
HormoneLog records. It does not assess. There is no score in it, no threshold, and nothing that says whether your HRT is working. That judgement belongs to the person who can examine you and change the prescription.
What to bring
| What | Why it matters |
|---|---|
| Start date, and every change with its date | The timeline is the thing being interpreted |
| Preparation, dose, route | A change in any of the three changes what is expected |
| Symptoms tracked separately, with dates | They do not move together |
| Side effects, with dates | Timing relative to a change is the whole signal |
| Bleeding pattern | Clinically relevant and easily forgotten |
| Adherence, honestly | Missed days matter and are common |
| Anything else that changed | New medication, illness, a period of bad sleep, major stress |
The last row is the one people leave out and clinicians want. A month of poor sleep from a work crisis, a new medication, or an illness all affect what you are attributing to the HRT.
Recording adherence honestly
This is uncomfortable and it is important.
Patches that came off in the shower. The week the prescription ran out before the repeat arrived. Gel applied at wildly different times of day. Days simply forgotten.
None of that makes you a bad patient and all of it changes the interpretation. A clinician told "it is not working" will consider a dose change. A clinician told "it is not working and I have missed roughly two days a week" will consider something entirely different, and one of those two conversations is useful.
The questions worth asking
Written down before you go, because appointments are short and the questions evaporate:
- What would you expect to have changed by now, and what would you expect to take longer?
- Is this dose and route the usual starting point for someone in my situation?
- What would you try next if this has not improved?
- How long should we give this before reviewing again?
- Which of my symptoms would you not expect this to help with?
That last question prevents a specific disappointment, which is judging a treatment against a symptom it was never likely to address.
The HRT review appointment. · HRT formulations explained. · How to log HRT changes.
Why the record beats the description
Two versions of the same six weeks:
Without a record: "I don't think it's doing anything."
With one: "Started 12 July, patch, changed to the higher dose on 9 August. Flushes were most days in July, now about twice a week. Night waking is unchanged, still three or four times most nights. Mood noticeably better from about week three. I missed four days in late July when the repeat was late."
The second version contains a dose change, a partial response, a non-response, a plausible confounder and an adherence gap. It is the difference between a consultation and a report of a feeling, and it takes no longer to say.
What to say when you are not taken seriously. · Why appointments go badly.
What this page does not do
It does not tell you whether to change dose, change preparation, add anything, or stop. Those are prescribing decisions, they depend on your history and your circumstances, and nothing on this site is a substitute for the person making them.
It also does not tell you what your symptoms mean. Several things that look like a failed response are not, and several things that look like a side effect have another cause. That is exactly why the record is worth keeping: it is the raw material for a decision, not the decision.
Why tracking perimenopause symptoms is worth it. · What menopause symptom scales are, and what they are not.
More in this section
About HormoneLog
HormoneLog is an iOS app from Baker Ventures LLC for tracking perimenopause and menopause symptoms and keeping an HRT record: what you took, at what dose, from when, and what changed afterwards. It is built for the appointment, where "it has been bad lately" is worth far less than a dated record of frequency and severity. The app is in development.
HormoneLog is a record-keeping tool. It does not diagnose, does not score you, and makes no claim about symptom relief. The guides on this site link to NICE, the NHS, the Menopause Society and peer-reviewed sources, and say plainly where the evidence is thin. Everything here is free and needs no account.
Questions and answers
How long does HRT take to work?
That depends on the preparation, the dose, the route and the symptom, and it is a question for your prescriber rather than an app. What is generally true is that different symptoms respond on different timescales, which is why a record separated by symptom is more informative than a single overall impression.
What should I record if HRT does not seem to be helping?
The start date and any dose or route change with its date, then the symptoms you are actually tracking, separately, with dates. Also record side effects, bleeding, and how you are taking it, because adherence and timing are among the first things a clinician will ask about.
Should I stop taking it if it is not working?
That is a decision for you and your prescriber, not one to make alone or on the basis of an app. Stopping, changing dose or changing preparation all have consequences that depend on your individual circumstances.
Why does the route of administration matter?
Different routes have different absorption characteristics and different considerations, which is one of the things a prescriber weighs when a preparation is not producing the expected effect. HormoneLog records which route and dose you were on and when, so the conversation has facts in it.
What questions should I ask at an HRT review?
What would you expect to have changed by now; is this dose and route the usual starting point for my situation; what would you try next if this does not improve; and how long should we give it before reviewing again. Written down beforehand, because appointments are short.
Does HormoneLog tell me whether my HRT is working?
No. It records what you took, when, and what you noticed. It produces no score, no threshold, and no assessment. Interpreting the record is the clinician's job, and the record is what makes that job possible.
HormoneLog. “When it does not seem to be working: what to record before the review appointment.” Baker Ventures LLC, September 7, 2026. https://hormonelog.bakerventuresstudio.com/guides/what-to-record-when-hrt-does-not-seem-to-be-working/